NorthShore University HealthSystem (formerly Evanston Northwestern Healthcare or ENH) is an integrated healthcare delivery system serving patients throughout the Chicago metropolitan area.NorthShore encompasses six hospitals, as of late 2021 — Evanston, Glenbrook, Highland Park, Skokie, Swedish, and Northwest Community — as well as NorthShore Medical Group with more than 70 offices and more than 800 primary and specialty care physicians, the Research Institute and Foundation. In total, the health system employs more than 10,000 people.NorthShore has a teaching affiliation with the University of Chicago Pritzker School of Medicine.
INTRODUCTION:Component separation technique (CST) facilitates anterior fascial closure but can increase wound morbidity and alter abdominal wall anatomy. Preoperative Botulinum toxin A (BTA) relaxes the oblique musculature, potentially reducing CST. This study evaluated trends in CST utilization following the adoption of BTA. METHODS:A prospectively maintained database was reviewed for patients who underwent open AWR (2016-2024). Primary outcome was proportion of CST use over time; secondary analysis compared early (2016-2017) versus late (2023-2024) cohorts. RESULTS:Among 1484 patients (mean age 58.8 ± 12.3 years; BMI 31.0 ± 5.8 kg/m2; defect size 211.5 ± 165.6 cm2), fascial closure was achieved in 99.5%. CST decreased from 48.0% to 19.9% (OR: 0.88,95% CI: 0.813,0.946;p < 0.001). BTA increased (2.9% to 11.0%), though annual change was not significant (OR: 0.98,95% CI: 0.898,1.071;p = 0.670). Between early and late cohorts (n = 384 vs. 356), defect size was similar (219.1 ± 160.6 vs. 213.8 ± 181.3 cm2;p = 0.367). There was a reduction in wound breakdown (6.5% vs. 0.8%) and recurrence (2.9% vs. 0.6%)(p < 0.05). CONCLUSION:Following the introduction of BTA, utilization of CST decreased and was accompanied by a reduction in wound morbidity.
This study aimed to evaluate the feasibility and benefits of tele-yoga in promoting mindfulness. A cross-sectional pilot study was conducted on patients (n=24) with heart failure at a tertiary referral hospital. The tele-yoga intervention was implemented in 6 group sessions over 8 weeks. Feasibility was assessed using indicators of adherence, retention, and user experience, whereas mindfulness was measured using the Mindful Attention Awareness Scale with a Cronbach’s alpha of 0.92. The statistical software RStudio was used for analysis. The results showed that most participants were women, with an average age of 47.4 years, middle-aged, and recently diagnosed. The attendance rate was 100%, and participants were highly satisfied with the experience. The average mindfulness score was 60, with a median of 59 and a SD of 17.81. This intervention proved to be feasible and acceptable, promoting concentration, emotional self-awareness, and stress management, thereby improving quality of life and disease management.
The introduction of new diagnostic information in pathology requires effective dissemination and adoption strategies. Although traditional methods like journals, meetings, and atlases have been used, they pose challenges in accessibility, interactivity, and performance validation. Digital pathology (DP) and artificial or augmented intelligence (AI) offer promising solutions to address these limitations. This paper advocates the use of DP and AI tools to facilitate the introduction of new diagnostic information in pathology. It highlights the importance of standardized training and validation sets, digital slide libraries, and AI-enhanced diagnostic tools. Although AI can improve efficiency and accuracy, it is crucial to address potential pitfalls such as over-reliance on AI, bias, and the need for human oversight. By leveraging DP and AI, the efficiency and accuracy of diagnosis, grading, staging, and classification can be augmented, ultimately improving patient care.
The effect of metformin on reducing symptom duration among outpatient adults with COVID-19 has not been studied. To assess metformin compared with placebo for symptom resolution during acute infection with SARS-CoV-2. The Accelerating COVID-19 Therapeutic Interventions and Vaccines platform evaluated repurposed medications for mild to moderate COVID-19. Between September 19, 2023, and May 1, 2024, participants 30 years or older with confirmed SARS-CoV-2 infection and 2 or more COVID-19 symptoms for 7 days or less were included at 90 US sites. Participants were randomized to receive metformin (titrated to 1500 mg, daily) or placebo for 14 days. The primary outcome was time to sustained recovery (3 consecutive days without COVID-19 symptoms) within 28 days of receiving the study drug. Secondary outcomes included time to clinic visit, emergency department (ED) visit, hospitalization, or death. Safety events of interest were hypoglycemia and lactic acidosis. Among 2991 participants who were randomized and received study drug, the median age was 47 (IQR, 38-58) years; 1895 (63.4%) were female, 25 (0.8%) were American Indian of Alaska Native, 77 (2.6%) were Asian, 350 (11.7%) were Black, African American, or African, 1392 (46.5%) identified as Hispanic or Latino, 8 (0.3%) were Native Hawaiian or other Pacific Islander, 2395 (80.1%) were White, and 2044 (68.3%) reported 2 or more doses of a SARS-CoV-2 vaccine. Among 1443 (48.2%) participants who received metformin and 1548 (51.8%) who received placebo, differences in time to sustained recovery were not observed (adjusted hazard ratio, 0.96; 95% credible interval [CrI], 0.89-1.03; P for efficacy = .11). The median time to sustained recovery was 9 days (95% CI, 9-10) for metformin and 10 days (95% CI, 9-10) for placebo. No deaths were reported; 103 participants reported clinic visits, ED visits, or hospitalization: 54 in the metformin group and 49 in the placebo group (hazard ratio, 1.25; 95% CrI, 0.82-1.78; P for efficacy = .13). Overall, 35 (1.2%) reported ED visits or hospitalization (1.1% in the metformin and 1.3% in the placebo group). Seven participants who received metformin and 3 who received placebo experienced a serious adverse event over 180 days. There were 4 episodes of participant-reported hypoglycemia in the placebo group and 2 in the metformin group. In this randomized clinical trial, metformin was not shown to shorten the time to symptom resolution in low-risk adults with COVID-19. The median days to symptom resolution was numerically but not significantly lower for metformin. Safety was not a limitation in the study population. ClinicalTrials.gov Identifier: NCT04885530
